Mahoro was a beautiful young girl of thirteen years. I met her in one of the reproductive health education sessions at Rwengo primary school. She was active and a quick learner. Mahoro was an exemplary girl. She was the head prefect at her school. She was an excellent performer. However, one would think she was over eighteen years. You see Mahoro was being put on a fattening diet of cow milk, ghee and bushera (millet flour) to grow her into womanhood. Many young men in my village fancied Mahoro as a desired wife. Fights broke out over her. However, Mahoro’ heart was in school. The fattening diet that her parents had put her on was against her will. She however had no choice in the matter.
One day, I was having conversation with one of my fellow Village Health Team (VHT) members when I got to know about Mahoro’s heart breaking story. The VHT told me that Mahoro had been forcefully married off. She had had a complicated birthing process and had developed fistula. My colleague had checked on her a few times. My heart sunk. Fistula was one of the worst after birth effects any mother could experience. The hole made in the birth canal and rectum arising majorly from obstructed labour lasting more than 24 hours was a traumatic experience. A woman who developed it was unable to control urine or stool, leading to other health complications. It was a condition that could easily be avoided but for limited access to better health services, fistula occurrences continue. The worse thing was that it mostly affected young girls who had the rest of their lives. I remembered a young girl in my neighbouring village who committed suicide because she could no longer live in isolation and stigma of fistula. I decided to pay Mahoro a visit the following day.
When I reached her home in Rwego village, her mother led me to a small hut where Mahoro stayed. She lived separately from the rest of her family. When Mahoro came out, I was not prepared for the sight. She had lost a lot of weight and had a stare of hopelessness. On the other hand, she then looked her more or less her age since she was not going through the fattening diets. When she saw me, she cried. She has a leso (wrapper) tied around her. She limped a little. I could tell that she was self-conscious because of the putrid smell she exuded. Such a bright young girl! Why did she meet such fate? I sat next to her to listen. Her mother left. Mahoro then tearfully narrated her ordeal.
“One day during my primary seven vacation, I was going to the well to collect water. I was with a team of other girls as we have always been advised to collect water in groups to avoid physical or sexual assault.
We were going back home after collecting water when we were ambushed by three assailants carrying sticks. We shouted for help. The quick ones threw their cans down and scattered in different directions. One unfortunate girl stumbled over a stone and got a sprain.
Given my weight, I could not run as swiftly as the others. I was captured by the three men who then hid me in a remote place far from my home for five days. There, each man took his turn of pleasure with me. In fact, the assailants were all brothers from the same family.
They then sent a message to my parents that they had me and that the parents should name their bride price. Like many girls from our tribe I have no say in the matter. Many women from my tribe were married off in this way. This is a popular practice called Kuhamba (to capture).
My parents agreed to a bride price of twenty heads of cattle. The marriage ceremony was organized and I become a bride against my will. I was to marry the eldest brother but like the custom demanded, all the males in the family including my father in law could sleep with me. In fact, I had to spent my wedding night with my father in law.
Nine months later I gave birth to triplets. I don’t even know who their actual father is because almost all the men in the family that I married into slept with me. I had no idea that I was carrying triplets. My husband’s family didn’t prioritize my need to go for Ante Natal Care at the Health Centre because they had a great Aunt who was a traditional birth attendant. My husband told me that the great Aunt had helped all his sisters and sisters-in-law to give birth without any complications. I would not be any different. I didn’t know any better. The birthing process was extremely painful. I experienced a lot of bleeding and tears. It was after some few days that realised that I could not hold urine or faecal matter. At first I thought that was how I was supposed to be after giving birth. However, my condition became worse that I could no longer share a room with my husband because of the smell. I could not nurse my babies. After one month, my husband sent me and my babies back to my parents saying I could no longer perform my wifely duties. Managing my menses is another thing all together with all the pain and discomfort of not having enough sanitary materials.
I asked Mahoro why she never went to hospital. If she had gone, her condition would be treated.
“Can I be treated?” Mahoro desperately asked. For the first time since our conversation, I saw her eyes light up.
“Yes, you can be treated. It takes some time to totally recover but you will get better.” I assured her.
However, the smile that had come on her face quickly disappeared. When I asked her what the problem was, she told me that she didn’t know who would take her to the health centre. Her mother- step mother didn’t care about her. Her father didn’t want to her to come close to their home. She was the oldest child in her family so she had only younger siblings. She had no one else to help her apart from the members of Village Health Teams.
After my conversation with Mahoro, I made up my mind to bring up the issue of fistula treatment and prevention at the following Kasamba Sub county council meeting. I made a narrative report and petition which I presented. I advocated for more resource allocations towards the community awareness and treatment of fistula. I also shared that there was need to educate young girls on prevention of teenage pregnancies while addressing the traditional practices that escalated child sexual abuse and child marriages. I reported that we had at least two documented cases of fistula in our location while others could have gone unreported. This was a high occurrence and the problem needed attention. I also presented Mahoro’s story. I saw a few leaders shed tears. When I finished presenting my case, a woman councillor stood up.
“Marrying off young girls is one of the causes of complicated births leading to fistula. We need to pass an ordinance against this custom of forcefully marrying off young girls in our community.”
“And in addition, the activities of the traditional birth attendants have to be regulated so that mothers are not put in danger,” another councillor stood up and said.
The council moved the motion to allocate resources to fistula awareness and treatment. After months, our district health team together with some community based organisations conducted a three-day outreach campaign against fistula at Konda health centre iii. I mobilized households to bring their daughters. Mothers came with their children. Many of the girls put on veils to avoid the shame of being seen. Fistula and shameare closely knitted.
Mahoro was among the girls that came for the treatment camps. After a few months, Mahoro was leaping like young calf. One day, she called for me and requested me to persuade her parents to take her back to school using the bride wealth of cattle. The cattle had multiplied hence could be used to pay for her school fees. Thankfully, her father agreed to take Mahoro back to school. He put her in a boarding school to help her concentrate on her studies.
“If you never reached out to me, I don’t know how my life would be now. I am grateful that you never turned your nose away from me during my time of illness. Musawo Sewava, may God bless you so much.” Mahoro tearfully told me as she gave me a basket of choice fruits in appreciation.
The 2020 Uganda Demographic and health survey shows that 2% of Uganda Women of reproductive age have experienced fistula meaning over 140,000 are living with the condition while 1,900 new cases are reported every year. It is also true that many cases go unreported. According to UNPFA many survivors of fistula are teenage girls.
UNFPA Uganda, 2021, Fact sheet on teenage pregnancy 2021 at https://uganda.unfpa.org/sites/default/files/pub- pdf/teenpregnancy_factsheet_3.pdf
2020 Uganda Demographic and health survey at https://www.newvision.co.ug/category/health/fistula-is-a-shame-to-the-medical-field-healt-NV_171034 (Secondary source)
Short story from Centre One, Novel by Sylvia Nalubega.